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Fatal Medication Errors

Dr. David Phillips, professor of sociology at the University of California in San Diego published a study in 2008 that highlighted an alarming trend: From 1983 to 2004, while deaths caused by firearms, fires, drownings, and traffic accidents decreased, the rate of deaths from prescription and over-the-counter drugs increased at a rapid clip.

In fact, Dr. Phillips noted that by 2004, "fatal medication errors" accounted for far more years of lost potential life than all accidents from firearms, fires, drownings, and non-medication poisonings combined.

Back when I operated a residential fasting clinic, it wasn't unusual to find that a patient was on several prescription drugs, sometimes without a clue about potential negative interactions. Here are a couple of examples that I randomly pulled from my files:

64 Year Old Caucasian Male

Lipitor - for high cholesterol
Diovan/HCT - for hypertension
Xanax XR - for anxiety and panic attacks
Lexapro - for depression
Flomax - for weak urine flow
Proscar - for high PSA
Valium - to help with sleep and anxiety
Aspirin - for cardiovascular support
Ambien - for insomnia
Dexadrine - for ADHD

These two patients were from the United States and Canada, respectively, which reflects my observation that generally, the medical professions in both countries seem to share the same basic apathy toward potentially dangerous drug interactions (most of the patients that visited my residential fasting clinic were from the States and countries overseas, while most of my outpatient clients are from Ontario).

It's never easy trying to sort through the drug cocktails that people have been put on over the years. And even in researching potentially harmful interactions, most of the time, I feel that these efforts are in vain. Why? Because textbooks can tell us that drug "A" only affects one pathway in the central nervous system, while drug "B" works its magic on an entirely separate pathway, but conventional medical practice seems to ignore big picture issues, like how much of any combination of prescription meds, over-the-counter drugs, and recreational drugs like alcohol is enough to cause significant damage to the stomach lining and liver, two areas that are forced to process most of everything we put into our bodies.

Really, can anyone out there tell us how much of various combinations of toxic substances is too much? I think it's pretty clear that the answer is no, at least not to any degree of accuracy, as who can take into account all possible combinations plus individual dispositions and varying health circumstances? Significant emotional stress alone is going to make someone's stomach lining more susceptible to becoming damaged by regular doses of extra strength ibuprofen than for the next person who isn't as stressed. How does anyone measure this and other risk factors?

Of grave concern is how easily any of us can experience fatal respiratory distress from taking a combination of alcohol and oxycodone (found in brand names OxyContin and Percocet to name just two). In fact, most combinations of alcohol and opioids can fatally suppress central nervous system activity. The same goes for various combinations of anti-anxiety medications plus opioids. Ditto for opioids and most prescription meds that are intended to induce sleep.

Two more dangerous combinations that are commonly used: Regular intake of acetaminophen and alcohol (increases risk of liver damage) and non-steroidal anti-inflammatories plus alcohol (increases risk of bleeding from the stomach). Given the number of drugs on the market (prescription, over-the-counter, and recreational), the list of risky combinations is truly endless.

Sadly, the profit motive is a root cause of the alarming increase in deaths due to fatal medication errors. I think it's safe to say that some pain clinics and physicians hand out prescriptions for highly addictive pain killing drugs without properly assessing the need for such meds. I think it's also safe to assume that some professionals are neglectful in educating their patients on proper use of said drugs, potential interactions, and what to do to address root causes of pain to try to get to a point where one can wean off addictive pain killers.

The reality is that for some medical professionals, handing out prescriptions has largely become a non-thinking, routine act that's repeated a hundred or more times per working shift to generate income. Education and financial incentive are generously supplied by the pharmaceutical industry (please see: A Sick Health Care System).

And even for those physicians who practice with their consciences fully turned on, the system itself makes it exceedingly difficult not to contribute to deaths due to medication errors. A physician friend of mine once lamented the number of patients on disability who he had to write prescriptions for every few months to keep them supplied with powerful pain killers; some of these people - quite happy to remain "disabled" and live off social welfare - routinely sell a portion of their supplies illegally, often for crazy profits, to allow them to meet their everyday expenses.

The bottom line is this: Today, it's shockingly easy to accidentally die from medication error. How natural is it for a person who is in pain and who's possibly a little depressed to find themselves taking an extra tablet of OxyContin with a few glasses of alcohol one night?

We have to remember that prescription drugs can and do kill. We need to have great respect for the physiological effects that tiny tablets can have within our bodies. Most importantly, we can take hope in knowing that if we consistently make healthy choices in what we think, what we eat, how we use our bodies, how much rest we get, and just how we go about our lives in general, we can reduce potential need for medication.

And in cases where we find ourselves using a conventional medical drug, let's remember that whenever possible, the goal should be to live in a way that maximizes our chances of no longer needing said medicine.

If you have any thoughts or comments on this topic, please feel free to share via the comments section below. And please consider sharing this information with family and friends who don't know how easy it can be to experience fatal medication error.

Comments

Thanks so much for sharing this very important information, Dr. Kim. A few years ago, my husband had the misfortune to be prescribed a drug that affected him in a very bad way. His personality was literally changing before my eyes and his ability to work was being compromised.

When I suggested that something was wrong, the prescribing doctor blew it off. Consequently, I did my own study and found that this drug could indeed cause the type of symptoms he was having. After seeing a neurologist who confirmed what I had discovered, my husband was taken off those drugs. Fortunately, he recovered--but it was extremely scary for a while.

Here in the States, it seems that many doctors know nothing about the side effects of the drugs they prescribe. If their local drug rep says they should prescribe it, they do. It's very frustrating being a patient because these doctors typically treat us as if we know nothing at all about our bodies and our health.

When considering the analytical implications of studying the potential effects that interactions between medications can produce in patients, the complexity of the issue is quite staggering. One main issue to address while trying to study the situation would be, as stated in the article, the immense number of possible combinations of medications. This number is very much inflated due to the fact that these are combinations of more than two or three medications. A responsible study would have to find a way of investigating the most common four or five way interactions, and their subsequent three and two way interactions. The numbers are baffling just to talk about. That combined with the fact that individual medications (as well as the interactions between them) have varying effects from individual to individual, make the necessary sample size another very big number.

It's no wonder why there isn't more information on the subject. Compiling it would be very costly, and pharma is well off ($$$) not having too much (published) scientific data to make them responsible for their products to such an extent.

As dr. kim suggests, its better not having to rely on pharmaceutical drugs, especially those which have questionable, not only secondary, but primary effects as well.

The point is not to FEAR medicine. Fear is an intensely negative and often counterproductive response. However, what we DO need is education and a healthy sense of caution, rather than abject and blind fear which I think is the true point of this article.

I am in my mid-twenties, and since leaving high school within the last 10 years I have lost several classmates to fatal drug interactions--mostly prescription drugs such as Vicodin or Oxycontin with alcohol.

It is easy (albeit tragic) to imagine a young person abusing prescription drugs at parties and losing their lives, but it is frightening to think that many elderly and seriously ill folks are being PRESCRIBED these highly addictive, potent, and powerful drug cocktails when a mistake could so easily be made with such serious consequences.

Find a doctor with ethics who truly listens to you, and many of us will be much better off (though mistakes can still be made). I generally adopt a policy of resisting powerful prescription drugs until I have explored my other options thoroughly and decide this is the best route--and to cease using them as soon as possible. I was once prescribed sleep medication for serious insomnia and could only bring myself to use it 4 times. It got me through a difficult period in my life while I was actively and sincerely engaging in other, natural ways to assist my sleeping.

It is quite a pity that a patient is helpless as he must have to under certain circumstances rely on his doctor's judgement which from the look of things, in the light of the article and the comments can be flawed sometimes. How much we long for the fulfillment of God's promise of of a sick free world

Very good article.It's become such a common practice to pop a pill for this and that and the other, and to take more pills to counteract the "side" effects of other ones. A quick fix has become modus operandi and we forget that life is work.

I agree with your comment that life is work! I believe our expectations of feeling just awesome all the time are unrealistic and unnatural. Emotional and physical pain and discomfort serve a purpose to let us know what we need to address. That said, I have clients with very chronic pain or depression for whom the medications are a God send. Consciousness when taking medication can move us toward healing.

Thanks for your excellent aricle on interaction of drugs, a very important subject for all of us and our children.

My thoughts on this sympathise greatly with the doctors dillema. We have moved into a very complicated period of medicine which grows daily but we still persist in trying to evaluate the risks in a disorganized manner.

The overworked doctor is expected to make many daily decisions regarding the choice and safety of any prescription. In this day and age it is unreasonable to expect one man to have the knowledge base for such a challenge, the daily research time alone exceeds the resource of one man.

Drugs will not go away and for many they are a lifeline, so it's essential to find a dependable answer to this problem. Current procedures are evidently not working.

I believe it requires a single source, easily interogated, on-line central data base. Updated on a mandatory daily basis by the pharmaceutical industry with all known contraindications, interactions etc, and enforced by the FDA or a similar capable authority.

I know I am responding to this, way after the fact, but I have not been able to read my mail for a while due to the fact that I am now raising my two grandsons, one who is blind and one who has autism, because their father, my son, just recently died from one of these fatal errors. He had no idea he would die when he took the drugs that were prescribed along with cough medicine off the pharmacy shelf he was told to take for the bad cold he had. I have seen three people in five years die this way and I think the doctors should know all the interactions before they hand this stuff out. Reading the labels gave no clue it would happen. Please, be careful of what you put in your body.

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The contents of this website are the opinions of Dr. Ben Kim unless otherwise noted. The information on this website is not intended as personalized medical advice and is not intended to replace the relationship that you have with your primary care provider. Any decisions you make with regard to your daily choices and medical treatments should be made with the help of a qualified health care provider.